The figures we report today showing a 12-fold variation in death rates following emergency abdominal surgery are shocking. In one hospital, patients have an almost one-in-two risk of dying should they be unfortunate enough to go under the knife. This is a level of risk that would be alarming in the developing world, never mind 21st-century Britain.
It is too soon to be sure of the reasons. So far we have only the raw data. Perhaps some of the variation can be explained by differences in demographics and in the health of local populations. But that is unlikely to explain all of it. And what is unforgivable, some might say criminal, is to fail even to examine the data.
Information about variations in death rates – from abdominal surgery and other surgical and medical interventions – has been circulated to hospitals since the early 1990s. Yet some disciplines are only now beginning to examine their performance. Why has it taken so long?
Pioneers in this field have been the heart surgeons, who, for more than a decade, have not only measured their death rates but published the results so that patients can see which surgeons are the safest and which hospitals have the best results. The effect has been to ratchet up performance across the board. Cardiac surgery in the UK is now the safest in Europe.
Other specialties have been slow to follow suit but what began as a trickle is now turning into a flood. Some 42 medical and surgical audits are now under way – including deaths following vascular surgery, hip fracture, and various forms of cancer. Emergency abdominal surgery is the latest.
These audits have on occasion thrown up alarming results, as today. But experience shows that the quickest way to address the failings exposed is to publish the results. Merely by collecting the data and comparing them with neighbouring hospitals, performance tends to rise.
Surgeons, department heads, and hospital chief executives who bury their heads in the sand are failing their patients and their institutions. They must be firmly reminded where their duty lies.